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UNDERGROUND STORAGE TANK DISPOSITION TRACKING RECORD <br />rr••r••r•r•••u••••••u•••••r••••r••r••r••••r•••••••••r•ur••••ur•••••••••••••r••••••�••••••••••••H••rr•• <br />SECIlON I - Public Health Services Tracking Sheet will accompany each tank affixed with its site identification number. <br />The Tracking Sheet is to be returned to Public Health Services within 30 days of acceptance of the tank by the disposal or <br />recycling facility. The permit holder is responsible for ensuring that this form Is completed and returned. <br />FACILITY NAME: Jefferson School District EPA Site 1lCAC 001001248 <br />FACILITY ADDRESS:7500 W. Linne Rd. Tracy, CA 95376 <br />TANK ID #39 - (7 Tank Description: 500 Gallon Diesel/ Gasoline/ Waste Oil <br />SECTION 2 - To be filled out by tank removal contractor: <br />Tank Removal Contractor: Jitn 1,11()rpe Oil Inc. DBA Rich -Mart Construction <br />Address: 351 N. Beckman Rd./ P.O. Box 351 City: Lodi, CA Zip: 95241-0357 <br />Phone #: 30( 9 1 462-458 1 Date Tank Removed: 1\a-$ \ Cl -2) <br />.....•.•••••••••••••••••••••.••••••••••••••••••••••••••Y•••••••r•Y•••••••••••••►•••t•••••••H••J••HHN••• <br />SECTION 3 - To be filled out by contractor "decontaminating tank': <br />Tank Decontamination Contractor: Jim 'Thorpe Oil DBA Rich -Mart Construction <br />Address: 351 N. Beclunan Rd./ F.O. Box 357 City: Lodi, CA _Zip: 95241-0357 <br />Phone #:( 209) 462-4581 <br />Authorized representative of contractor certifying through signature below that the tank has been decontaminated in an <br />approved manner as�required by Cal EPA. - J <br />Sivnature- I ra1 1 Nit tz- . �Il.d't.121 Title: (/ <br />•.rr•u•••♦r•••••••••r•r•••u•r••••u•••r•••�•••••r•••r••••r•••r••u•••••••••••u•••••••••••••u••••••••••• <br />SECTION <br />Tank is <br />Facility Na <br />Address: <br />- To be signed and dddoted by an authorized representative of the treatment, storage, or disposal facility <br />free �iti �l� s�udyegipaA hydrocarbon vapors upon delivery to Schnitzer Steel. <br />Phone #: ( 916 <br />Schnitzer Steel Products <br />12000 Folsom Blvd. <br />985-4810 <br />Date Tank Received: / <br />Ea 23 049 (Revised 7-10-92) Page 10 <br />City:Rancho Cordova Zip: 95742 <br />